Objective
The prognosis of hypopharyngeal cancer is one of the worst among head and neck cancers. However, the most appropriate treatment for hypopharyngeal cancer has not yet been determined. The traditional treatment for hypopharyngeal cancer is operation plus radiotherapy, if the latter is needed. Many patients are not willing to receive operation because the operation for hypopharyngeal cancer usually comprises total laryngectomy due to the late stage when the illness is diagnosed. In recent years, with the improvement of radiotherapy and chemotherapy, hypopharyngeal cancer patient can receive chemoradiation as initial treatment (also known as organ preservation therapy). The purpose of this research is to compare the survival rate between surgery and chemoradiation therapy and hopefully to offer some suggestions in the treatment of hypopharyngeal cancer in the future.
Methods
We retrospectively analyzed 209 hypopharyngeal cancer patients whose diseases were diagnosed and treated in Taichung Veteran General Hospital from January 1, 1996 to February 28, 2006. Among them, 123 patients received operation as initial treatment and 86 patients received chemoradiation therapy as initial treatment.
Results
Overall, the five year survival rates in the treatment of hypopharyngeal cancer in Taichung Veteran General Hospital were: stage I: 100%， stage II: 67.34%，stage III: 59.12，stage IVa＋IVb:33.40%. The five year survival rate was 48.3% for patients who received surgey as initial treatment and 34.6% for patients who received chemoradiation therapy as initial treatment. The difference between survival rates of the two treatment groups was statistically significant(p＝0.0003<0.05). The five year survival rates of the surgery first group in each stage were: stage I: 100%，stage III: 76.4%，stage IVa+IVb:38.00%. The three year survival rate of stage II of the surgery first group was:30%. The five year survival rates of the chemoradiation first group in each stage were: stage II: 100%，stage III: 30.0%，stage IVa+IVb:28.40%.
Conclusion
The result of this research shows that in treating hypopharyngeal cancer, the patients who received surgery as initial treatment had significantly higher survival rate than those who received chemoradiation therapy as initial treatment. According to this result, we suggest that advanced stage hypopharyngeal cancer patients should choose surgery as initial treatment rather than chemoradiation therapy as initial treatment just to preserve the organ. We also hope that more literature about the treatment of hypopharyngeal cancer can be reported, so that the most appropriate way to treat this dangerous cancer can be secured.
